Provider Demographics
NPI:1609232438
Name:KIMBERLY'S ELDER KARE KOTTAGE
Entity Type:Organization
Organization Name:KIMBERLY'S ELDER KARE KOTTAGE
Other - Org Name:ALL ABOUT SENIORS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-483-2433
Mailing Address - Street 1:2770 MOORPARK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-3153
Mailing Address - Country:US
Mailing Address - Phone:408-483-2433
Mailing Address - Fax:408-554-6656
Practice Address - Street 1:2770 MOORPARK AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-3153
Practice Address - Country:US
Practice Address - Phone:408-483-2433
Practice Address - Fax:408-554-6656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA435294206310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility